Clinical Evaluation of Diabetic Foot Ulcers Using the SINBAD (Site, Ischemia, Neuropathy, Bacterial Infection, Area, and Depth) Scoring System: A Prospective Study

Background Diabetic foot ulcers (DFUs) are a serious complication of type 2 diabetes mellitus (T2DM), leading to significant morbidity, prolonged hospitalization, and risk of limb amputation. The SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, Area, and Depth) scoring system evaluates ulcer severity through six clinical parameters and has been proposed as a valuable tool for predicting outcomes. This prospective study aimed to assess the clinical utility of the SINBAD scoring system in predicting surgical outcomes, including ulcer healing, limb salvage, and amputation rates in patients with T2DM presenting with DFUs. Materials and methods A total of 130 T2DM patients with clinically confirmed DFUs were enrolled over one year at a tertiary care center. Ulcers were scored using SINBAD parameters: site, ischemia, neuropathy, bacterial infection, area, and depth. Patients received individualized surgical management based on SINBAD scores. Follow-up was conducted weekly for one month and then monthly for six months. Primary outcomes included ulcer healing, limb salvage, and amputation (minor and major). Results The mean age was 62.65±12.5 years, with a male predominance (67.7%). The forefoot was the most common site of ulcers (86.1%), with ischemia present in 35.4%, neuropathy in 65.4%, and bacterial infection in 91.5%. Most ulcers (95.4%) were larger than 1 cm². SINBAD scores of 3 were most common (55.4%). Healing rates were highest in patients with SINBAD scores of 1 (90%), while major amputations occurred predominantly in scores 5 and 6 (75% and 100%, respectively). The association between SINBAD scores and clinical outcomes was statistically significant (p<0.05). Conclusion The SINBAD scoring system reliably stratifies DFU severity and predicts healing and amputation risks, supporting its use as a practical tool in clinical decision-making to improve patient outcomes.